Surgical instrument having self-regulating dielectric heating of its cutting edge and method of using the same

ABSTRACT

The cutting edge of a scalpel blade is heated to an elevated preselected constant operating temperature for cutting tissue with simultaneous hemostasis by dielectric heating of the internal structure of the blade in the region along the cutting edge. Selective heating of regions of the cutting edge that are locally cooled by contact with tissues during surgical cutting is provided for by constructing the heating elements of the blade of ferroelectric materials that have a Curie point in the operating temperature range and that provide large increases in loss factor (the product of relative dielectric constant times the ratio of loss current to charging current) for temperature decrements below the Curie point.

RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.558,333 filed on Mar. 14, 1975, now Pat. No. 4,207,896, which is acontinuation in part of U.S. patent application Ser. No. 534,756 filedDec. 2, 1974, now Pat. No. 4,089,336, which is a continuation of U.S.patent application Ser. No. 63,645 filed Aug. 13, 1970, now abandonedwhich is a continuation of U.S. patent application Ser. No. 681,737filed Nov. 19, 1967, now abandoned.

BACKGROUND OF THE INVENTION

The control of bleeding during surgery accounts for a major portion ofthe total time involved in an operation. The bleeding that occurs fromthe plethora of small blood vessels that pervade all tissues whenevertissues are incised obscures the surgeon's vision, reduces hisprecision, and often dictates slow and elaborate procedures in surgicaloperations. It is well known to heat the tissues to minimize bleedingfrom incisions, and surgical scalpels which are designed to elevatetissue temperatures and minimize bleeding are also well known. One suchscalpel transmits high frequency, high energy sparks from a smallelectrode held in the surgeon's hand to the tissues, where they areconverted to heat. Typically, substantial electrical currents passthrough the patient's body to a large electrode beneath the patient,which completes the electrical circuit. Discharge of sparks andtemperature conversion in the tissue are poorly controlled indistribution and intensity, and erratic muscular contractions in thepatient are produced so that this apparatus cannot be used to performprecise surgery. Further, apparatus of this type frequently producesevere tissue damage and debris in the form of charred and dead tissue,which materially interfere with wound healing.

Another well-known surgical scalpel employs a blade with a resistiveheating element which cuts the tissue and provides simultaneoushemostasis. Although these resistive elements can be readily brought toa suitably high and constant temperature in air prior to contactingtissues, as soon as portions of the blade come in contact with tissues,they are rapidly cooled. During surgery, non-predictable andcontinuously varying portions of the blade contact the tissues as theyare being cut. As the blade cools, the tissue cutting and hemostasisbecome markedly less effective and tissue tends to adhere to the blade.If additional power is applied by conventional means to counteract thiscooling, this additional power is selectively delivered to the uncooledportions of the blade, frequently resulting in excessive temperatureswhich may result in tissue damage and blade destruction. This resultsfrom the fact that in certain known resistively heated scalpels, theheating is a function of the current squared times the resistance (I²R). In conventional metallic blades of this type, the higher thetemperature of any blade portion, the greater its electrical resistance,and consequently the greater the incremental heating resulting fromincremental power input.

It is generally recognized that to seal tissues and effect hemostasis itis desirable to operate at a temperature between 300° C. and 1000° C.And for reasons noted above, it is desirable that electrothermalhemostatic surgical cutting instruments include a mechanism by whichpower is selectively delivered to those portions of the blade that arecooled by tissue contact so that the cutting edge may be maintained at asubstantially uniform operating temperature within the desired optimalrange. Recently, hemostatic scalpels have been described (see, forexample. U.S. Pat. Nos. 3,768,482 and 3,826,263) in which thetemperature-controlling mechanisms include resistive heating elementsdisposed on the surface of the scalpel blade. However, such instrumentsrequire precision in fabricating the dimensions of the heating elementsto obtain the desired resistances. And such resistive heating elementsmay be subjected to variations in resistance during use, as tissuejuices and proteins become deposited upon the surface of the blade.

SUMMARY OF THE INVENTION

The present invention provides a surgical cutting instrument in whichthe cutting portion of the blade is brought to an elevated temperatureby dielectric heating of a scalpel constructed of a nonconductingmaterial. Dielectric heating depends on the heat generated by dipolerotation in a dielectric material caused by an alternating electricfield.

All materials can be characterized from an electromagnetic considerationwith respect to two parameters, namely, the magnetic permeability μ, andthe dielectric constant ε. Most dielectric materials are nonmagnetic andthe permeability is equal to that of free space. Therefore, thecontrolling parameter in such materials is the dielectric constant,which may be very large relative to free space. To incorporate both aloss current and a charging current, the dielectric constant of amaterial is generally written in complex form ε=ε'-jε" where ε' is thereal dielectric constant and ε" is the loss factor. The dielectricconstant is also often written in relative form k=k'-jk" where k=ε/ε_(o)and ε_(o) is the constant of free space.

The power generated in a dielectric is given by

    p=0.55(10.sup.-12)E.sup.2 fk' tan δ,

in watts/cm³, where E is the electric field in volts per centimeter, fis the frequency in hertz, k' is the relative dielectric constant, andtan δ is the ratio of loss current to charging current or k"/k'. Thepower generated in a dielectric is therefore dependent upon the voltageapplied to it, the frequency, and the complex dielectric constant of thematerial.

In the present invention , the tissue-cutting edge of a blade-shapedstructure including a dielectric element is heated by the applicationthereto of a high frequency electrical signal. The electrodes aredisposed on the surfaces of the dielectric element in a manner whichestablishes a high frequency electric field within the element in aregion thereof near the tissue-cutting edge.

Further, selective heating of those portions of the cutting edge thatare cooled by tissue contact in order to maintain cutting temperaturesufficiently constant (i.e., temperature self-regulation) may beaccomplished by fabricating the element of a dielectric material inwhich the loss factor k" (i.e., the product of the relative dielectricand the tan δ [ratio of loss current to charging current, or k"/k'])increases with decreasing temperature. Since each local region of thedielectrically heated material is directly affected by the highfrequency electric field, each local region may have its operatingtemperatures regulated independently of the operating temperatures ofadjacent regions. Thus, even in the presence of unpredictable andsubstantial variations in cooling of the various regions of the heatededge resulting from the edge being manipulated to cut tissues, theheated tissue-cutting edge can be maintained within a suitably constanttemperature range.

Ferroelectric materials are examples of dielectrics that have thisproperty near their Curie points. The Curie point of a ferroelectricmaterial is the temperature at which, from an electro-magneticstandpoint, the real dielectric constant experiences a sharp peak andthe loss tangent experiences a sharp increase with decreasingtemperature. FIG. 3 shows these properties for the ferroelectric bariumtitanate. It can be seen that there is approximately a 5 to 1 increasein k"(k'×tan δ) as the temperature drops from 170° C. to 120° C.Therefore, if this material were used to heat the cutting edge of ascalpel blade in accordance with the present invention, and if aconstant frequency and voltage were assumed, there would be a 5 to 1heating increase as the temperature dropped from 170° C. to 120° C. Toobtain self-regulation in the 300° C. to 1000° C. range, as is desirablein surgical procedures, it is desirable to have a material with a Curiepoint within this latter temperature range. There are ferroelectricmaterials available with a wide range of Curie points. FIG. 4 shows theeffect on the real dielectric constant of the addition of lead titanateto barium titanate. The Curie point is moved upward in temperature asthe percentage of lead titanate increases. Lead zirconate titanate is anexample of a commercially available material with a Curie point in the400° C. range.

The ferroelectric materials, in addition to having a Curie point thatdielectric materials in general do not possess, have large values of k'.This permits generating the desired power in the samll volume ofmaterial that is present in the scalpel at voltages that are attainablewith standard oscillators and that are small enough to prevent breakdownin small diameter coaxial transmission lines. The following tabulationillustrates the difference in power generated within the volume that istypically to be expected between the electrodes on a scalpel blade. Twodielectrics are illustrated, one a ferroelectric and one a moreconventional dielectric such as glass.

    ______________________________________                                        Dielectric Constant,                                                                       Frequency,           Watts in                                    k'-jk"       Hertz       Volts/cm 0.01 cm.sup.3                               ______________________________________                                          4-j    0.01    4(10.sup.7) 2(10.sup.3)                                                                          10.sup.-2                                 1700-j   34      4(10.sup.7) 2(10.sup.3)                                                                          30                                        ______________________________________                                    

DESCRIPTION OF THE DRAWINGS

FIG. 1 is a partial side view of a surgical cutting instrument accordingto one embodiment of the present invention;

FIG. 2 is an end sectional view of one embodiment of a blade-shapedportion of an instrument as shown in FIG. 1;

FIG. 3 is a graph showing the temperature dependence of dielectricconstant and loss tangent of barium titanate ceramic; and

FIG. 4 is a graph showing dielectric constant as a function oftemperature, with the percent of lead titanate in barium titanate as avariable.

DESCRIPTION OF THE PREFERRED EMBODIMENT

Referring now to FIG. 1, there is shown in cutaway side view a surgicalcutting instrument which has a blade-shaped element 9 that is suitablyattached to a handle 11. An electrode 13 is disposed on one major faceof the element 9 near the periphery thereof and another similarelectrode 15 (not shown) is disposed on the opposite major face inapproximate registration with electrode 13 on the one major face. Theseelectrodes 13, 15 may be connected, respectively, to the terminals of asource 17 of radio frequency signal in such a manner that a radiofrequency electric field is established within the element 9 between theelectrodes 13, 15 in response to the radio frequency signal appliedthereto. This causes local heating near the peripheral edges of theelement 9 in the manner as previously described. And since the radiofrequency electric field established between electrode 13 and 15independently affects the local regions of the dielectric, the operatingtemperatures of local regions may be regulated independently of theoperating temperatures of adjacent regions. With a material which hasthe desirable characteristics previously discussed in connection withthe graphs of FIGS. 3 and 4, and at the selected operating temperatures,the entire cutting edge can be maintained within a suitably constanttemperature range despite the irregular and unpredictable manner inwhich the various regions of the cutting edge are used.

The sectional view of FIG. 2 shows the arrangement of electrodes 13 and15 disposed on opposite faces of element 9 in approximate patternregistration adjacent the tissue-cutting edge of the element 9. Aninsulating material 21 such as silicon dioxide may be deposited on themajor surfaces of element 9 and over the respective electrodes 13 and 15to insulate the body of a patient from electrical signals appearing onthese electrodes.

The radio frequency signal source 19 may be adjustable in signalamplitude or in frequency, or both, to adjust the ambient operatingtemperature of the cutting edge in air.

I claim:
 1. A blade comprising:a cutting means including a cutting edgeand a dielectric means disposed in the region along said cutting edgefor dissipating power in inverse relation to temperature over a portionof a temperature range, said power so dissipated being generated inresponse to an alternating electric field applied to said dielectricmeans; and electrode means disposed adjacent said dielectric means forapplying said alternating electric field to said dielectric means.
 2. Ablade as in claim 1 wherein said dielectric means exhibits a Curie pointabout which a transition in loss factor with temperature occurs.
 3. Ablade as in claim 2 wherein said dielectric means includes ferroelectricmaterial.
 4. A blade as in claim 1 comprising a layer of insulatingmaterial disposed over the electrode means.
 5. A blade as in claim 1wherein the dielectric means has an electrical parameter that varies asa function of temperature to increase power dissipation in the regionsof said cutting edge which are selectively cooled.
 6. A blade as inclaim 1 wherein the dielectric means has a loss factor which variesinversely with temperature.
 7. A blade as in claim 1 for hemostaticsurgery wherein the dielectric means exhibits a Curie point transitionin loss factor within the range of temperatures between about 300° C.and about 1000° C.
 8. A blade as in claim 1 comprising source means ofalternating electrical signal coupled to the electrode means of theblade for establishing said alternating electric field within thedielectric means.
 9. A method of cutting using a blade having a cuttingedge operating at an elevated temperature and a dielectric meansdisposed in the region along the cutting edge, said method comprisingthe steps of:establishing an alternating electric field within thedielectric means; and dissipating power in the dielectric means near thecutting edge in inverse relation to temperature over a portion of atemperature range, said power so dissipated being used to heat thecutting edge via dielectric losses associated with said alternatingelectric field established in the dielectric means.
 10. The method ofcutting as in claim 9 wherein in the step of dissipating power theelectrical parameter which varies with temperature is the loss factor ofthe dielectric material.
 11. The method of cutting as in clain 10wherein the step of dissipating power, the dielectric material exhibitsa Curie point about which a transition in loss factor with temperatureoccurs.
 12. The method of cutting as in claim 11 for use in hemostaticsurgery wherein in the step of dissipating power, the dielectricmaterial exhibits a Curie point transition in loss factor within therange of temperatures from about 300° C. to about 1000° C.
 13. Themethod of cutting as in claim 9 wherein in the step of establishing analternating electric field, at least one of the frequency and amplitudeof an alternating signal is altered in response to changes intemperature along the cutting edge.
 14. A surgical blade for cuttingtissue with simultaneous hemostasis, said surgical blade comprising:acutting means including a cutting edge and a dielectric means disposedin the region along said cutting edge for dissipating power in inverserelation to temperature over a portion of the temperature range betweenapproximately 300° C. and 1000° C., said power so dissipated beinggenerated in response to an alternating electric field applied to saiddielectric means; and electrode means for applying said alternatingelectric field to said dielectric means.
 15. The surgical blade claimedin claim 14 wherein said dielectric means exhibits an increase in lossfactor at Curie point transition within said temperature range.
 16. Asurgical blade claimed in claim 14 comprising a layer of insulatingmaterial disposed over the electrode means to electrically insulatetissue being cut from electrical shock.